Individual
LICETE F LAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
968 FAIRFIELD AVE, BRIDGEPORT, CT 06605-1116
(203) 330-6000
(203) 382-1468
Mailing address
968 FAIRFIELD AVE, BRIDGEPORT, CT 06605-1116
(203) 330-6000
(203) 382-1468
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
04/03/2009
Last updated
04/03/2009
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